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General NPI Number Information
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NPI Number | 1730463662
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Entity Type | Individual
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Provider Name | DOUGLAS W LIM D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/11/2011
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 728 WEST 19TH ST. SUITE B
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City | COSTA MESA
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State | CA
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Zip | 92627-6148
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Country | US
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Telephone | 949-650-8186
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Fax |
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Provider Business Mailing Address
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Address Line | 728 WEST 19TH ST. SUITE B
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City | COSTA MESA
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State | CA
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Zip | 92627-6148
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Country | US
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Telephone | 949-650-8186
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 29938
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License Number State | CA
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